Evaluating the microbial pattern of periprosthetic joint infections of the hip and knee

Rosteius, Thomas; Jansen, Oliver; Fehmer, T.; Baecker, Hinnerk; Citak, Mustafa; Schildhauer, Thomas A.; Geßmann, Jan

doi:10.1099/jmm.0.000835

Cited by 77 publications

(67 citation statements)

References 24 publications

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“…We also found that MDR nonfermenters and MDR S. aureus rates were higher at tropical sites vs. subtropical. Reported cases of MDR nonfermenters in the orthopaedic literature are too low to be comparable; however, we note that our rates of MDR S. aureus are consistent with other studies [20,21,[23][24][25][26]. In their assessment of pathogens cultured from surgical site infections following joint arthroplasty and spinal fusions, Norton et al found that 33% of S. aureus was methicillin-resistant and similarly, Dudareva et al identified that 22.5% of S. aureus species cultured from chronic osteomyelitis patients in the United Kingdom were MDR [20,24].…”

Section: Discussionsupporting

confidence: 91%

Bacterial Profile, Multi-Drug Resistance and Seasonality Following Lower Limb Orthopaedic Surgery in Tropical and Subtropical Australian Hospitals: An Epidemiological Cohort Study

Vickers

Ballard

Harris

et al. 2020

IJERPH

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We aimed to describe the epidemiology, multi-drug resistance and seasonal distribution of bacteria cultured within 12 months following lower limb orthopaedic surgery in tropical and subtropical Australian hospitals between 2010 and 2017. We collected data from four tropical and two subtropical hospitals. Categorical variables were examined using the Pearson Chi-squared test or Fisher’s Exact test, and continuous variables with the Student t-test or Mann–Whitney U test. A Poisson regression model was used to examine the relationship between season, weather and the incidence of Staphylococcus and nonfermentative species. We found that at tropical sites, nonfermenters (Pseudomonas aeruginosa and Acinetobacter baumannii) were more common (28.7% vs. 21.6%, p = 0.018), and patients were more likely to culture multi-drug-resistant (MDR) nonfermenters (11.4% vs. 1.3%, p = 0.009) and MDR Staphylococcus aureus (35.9% vs. 24.6%, p = 0.006). At tropical sites, patients were more likely to be younger (65.9 years vs. 72.0, p = < 0.001), male (57.7% vs. 47.8%, p = 0.005), having knee surgery (45.3% vs. 34.5%, p = 0.002) and undergoing primary procedures (85.0% vs. 73.0%, p = < 0.001). Species were similar between seasons in both tropical and subtropical hospitals. Overall, we found that following lower limb orthopaedic surgery in tropical compared with subtropical Australia, patients were more likely to culture nonfermenters and some MDR species.

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Section: Discussionsupporting

confidence: 91%

Bacterial Profile, Multi-Drug Resistance and Seasonality Following Lower Limb Orthopaedic Surgery in Tropical and Subtropical Australian Hospitals: An Epidemiological Cohort Study

Vickers

Ballard

Harris

et al. 2020

IJERPH

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“…Systemic antibiotic therapy is a critical aspect of treating PJI, however, increasing bacterial resistance to conventional antimicrobial agents creates significant treatment challenges 146,147 . Over the past decade, novel antibiotics with broad‐spectrum activity against Gram‐positive organisms such as daptomycin, which is a cyclic lipopeptide, and linezolid, an oxazolidinone, have been developed to expand treatment options for resistant infections 108–110 .…”

Section: New Advancements In the Treatment Of Musculoskeletal Infectionmentioning

confidence: 99%

New developments and future challenges in prevention, diagnosis, and treatment of prosthetic joint infection

Ricciardi

Muthukrishnan

Masters

et al. 2020

Journal Orthopaedic Research

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Prosthetic joint infection (PJI) is a devastating complication that results in substantial costs to society and patient morbidity. Advancements in our knowledge of this condition have focused on prevention, diagnosis, and treatment, in order to reduce rates of PJI and improve patient outcomes. Preventive measures such as optimization of patient comorbidities, and perioperative antibiotic usage are intensive areas of current clinical research to reduce the rate of PJI. Improved diagnostic tests such as synovial fluid (SF) α‐defensin enzyme‐linked immunosorbent assay, and nucleic acid‐based tests for serum, SF, and tissue cultures, have improved diagnostic accuracy and organism identification. Increasing the diversity of available antibiotic therapy, immunotherapy, and alternative implant coatings remain promising treatments to improve infection eradication in the setting of PJI.

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“…Тенденцию к увеличению числа высокорезистентных возбудителей ППИ, таких как MRSE, бактерий-продуцентов бета-лактамаз расширенного спектра, ампициллин-резистентных энтерококков, Acinetobacter spp. и ванкомицин-устойчивых энтерококков отмечают также T. Rosteius с соавторами [3]. Очевидно, что уровень резистентности возбудителей значимо влияет на исход лечения вне зависимости от хирургической тактики.…”

Section: статистический анализunclassified

“…Все современные лечебные алгоритмы указанной патологии учитывают длительность и характер течения инфекционного процесса, состояние тканей, окружающих эндопротез, вид возбудителя, его антибиотикорезистентность, а также состояние пациента [1]. В последние годы особое внимание стали уделять полирезистентным возбудителям ППИ, снижающим эффективность санирующих операций и этиотропной антибактериальной терапии и нередко приводящим к многократному рецидивированию инфекционного процесса [2,3,4]. Это привело к закономерному появлению в научной литературе нового термина «difficult to treat», характеризующего трудноизлечимую перипротезную инфекцию (ТИ ППИ), обусловленную трудными для эрадикации (ТДЭ) возбудителями, устойчивыми к антибиотикам, активными в отношении микробных биопленок.…”

Section: Introductionunclassified

Difficult-To-Treat Periprosthetic Hip Infection: Outcomes of Debridment

Ливенцов

Божкова

Божкова³

et al. 2019

Traumatology and Orthopedics of Russia

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Purpose of the study — to compare management efficiency for difficult-to-treat periprosthetic hip joint infection (PJI) during resection arthroplasty with grafting by vastus lateralis pedicle island flap in comparison with insertion of an antimicrobial-loaded cement spacer. Material and Methods. 132 patients were included into the retrospective study who underwent treatment from 2012 until 2018 including removal of orthopaedic implant, radical surgical debridement of infection focus, resection arthroplasty with grafting by vastus lateralis pedicle island muscle flap (PMF group — 57 patients) or insertion of antibacterial-loaded cement spacer (AMS group — 75 patients). The authors examined medical histories, nature of infection process, infection agent type, laboratory data in respect of systemic inflammation, size of bone defects, follow up status and remission of PJI in the late period. Results. 89.4% of patients (n = 51) who underwent grafting by vastus lateralis pedicle island flap had a history of 3 and more prior surgical procedures in the same area. At the same time the share of such patients in the spacer group was only 38.6% (n = 29) (p0.0001) while the share of patients with two and more recurrences was 78.9% (n = 45) and 25.3% (n = 19), respectively (p0.0001). No significant variances were observed between the groups in respect of type composition of PJI microbial infection agents. The infection in a vast majority of patients in both groups was caused by microbial association: 77.2% and 72.0% in PMF and AMS groups, respectively. In the early postoperative period secondary revision of surgical site was performed in 35% and 28% of cases in PMF group (n = 20) and AMS group (n = 21), respectively, including due to recurrent infection in 15.8% and 28% of cases, respectively. Stable remission of difficult-to-treat PJI in PMF group was 96.5% and 45.3% in AMS group. Conclusion. Despite some cases that required secondary revisions in early postoperative period the resection arthroplasty in combination with pedicle muscle flap can be considered a surgery of choice for management of recurrent difficultto-treat PJI with feasible re-implantation of prosthesis against the stable remission of infection.

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Evaluating the microbial pattern of periprosthetic joint infections of the hip and knee

Abstract: Patients suffering PJI present a certain risk profile with many comorbidities, e.g. high age and obesity. The observed microbiological pattern demonstrates the rise of high-resistance pathogens.

Cited by 77 publications

References 24 publications

Bacterial Profile, Multi-Drug Resistance and Seasonality Following Lower Limb Orthopaedic Surgery in Tropical and Subtropical Australian Hospitals: An Epidemiological Cohort Study

Bacterial Profile, Multi-Drug Resistance and Seasonality Following Lower Limb Orthopaedic Surgery in Tropical and Subtropical Australian Hospitals: An Epidemiological Cohort Study

New developments and future challenges in prevention, diagnosis, and treatment of prosthetic joint infection

Difficult-To-Treat Periprosthetic Hip Infection: Outcomes of Debridment

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